Rates of women who are opting for preventive mastectomies, such as Angeline Jolie, have increased by an estimated 50 percent in recent years, experts say. But many doctors are puzzled because the operation doesn't carry a 100 percent guarantee, it's major surgery -- and women have other options, from a once-a-day pill to careful monitoring.

Starting Dec. 14, the HPV, or human papillomavirus vaccine will no longer be on the list of immunizations immigrant females ages 11 to 26 must receive before becoming legal permanent residents.

The U.S. Centers for Disease Control and Prevention made the change on Friday. In a Federal Register entry, the CDC said it will require immunizations for which there is a public health need at the time the person immigrates or changes their status to green card holder.

"More than half of the immigrants who come to the U.S. seeking opportunity are women," Silvia Henriquez, executive director of the National Latina Institute for Reproductive Health, said in a statement. "We thank the CDC for restoring their dignity and reproductive justice."

Girls and women seeking to become legal permanent U.S. residents were required to get at least the first dose of the HPV vaccine, which protects against some strains of the virus blamed for cervical cancer. It was added to the list of required vaccinations for immigrants in July 2008.

Soon after, a coalition of more than 100 immigrant, health and women's advocacy groups challenged the requirement, saying it was unfair to require the HPV vaccine for immigrants but not for most U.S. citizens.

Attempts to require the vaccine for American girls has brought emotional debate and complaints that such mandates intrude on family decisions about sex education. In Texas, lawmakers fought off a 2007 order by Gov. Rick Perry requiring the shots for sixth-grade girls amid questions about vaccine's safety, efficacy and cost.

At a price of $400 to $1,000 for the three-shot series, the vaccine also was an added burden on green card applicants already paying more than a thousand dollars in application fees and hundreds of dollars for mandatory medical exams. Insurance companies do not cover health services required for immigration purposes, advocates pointed out.

"It also put the financial burden on the individual woman and her family," Gabriela Valle, senior director of community outreach and mobilization for California Latinas for Reproductive Justice, said Monday. "Not only are you taking my rights to make an informed decision over my body, over myself, over my daughter, but you're having me pay for it as well."

The U.S. Food and Drug Administration approved Gardasil in 2006 to protect against the human papillomavirus. The CDC immunization advisory committee quickly followed up by recommending it for girls and young women.

For U.S. citizens, the committee's recommendations serve only to provide guidance on vaccines. But a 1996 change to the nation's immigration laws required anyone seeking permanent residency to get all the vaccinations recommended by the committee.

The CDC's newly adopted criteria to determine which vaccines will be required for immigrants says the vaccine must be age appropriate. It also must protect against a disease that has the potential to cause an outbreak, has been eliminated in the U.S. or is in the process of being eliminated from the country.

The change also means the Zoster vaccine to protect against shingles won't be required of immigrants 60 or older.

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